Provider Demographics
NPI:1053414482
Name:STRAUTMAN, JON ERIC (RPH)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:ERIC
Last Name:STRAUTMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-1650
Mailing Address - Country:US
Mailing Address - Phone:812-926-0960
Mailing Address - Fax:812-689-5955
Practice Address - Street 1:202 W. FIRST NORTH ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:IN
Practice Address - Zip Code:47042
Practice Address - Country:US
Practice Address - Phone:812-689-5955
Practice Address - Fax:812-689-5782
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist